An OB/Gyn doctor living the Paleo lifestyle

Month: October 2015

The last time I posted, I had finally gotten one good night’s rest. Well, later that night I developed mastitis. I had all of the classic symptoms. First, I noticed one area of my breast still hurt despite finishing feeding and the breast having been emptied. I tried massaging the area to see if it would help. I’d also been dealing with engorgement, so I iced it briefly. I then noticed it getting a little red, but wasn’t sure if it was from all of the manipulation.

Shortly thereafter, I started to feel like I was coming down with the flu. At that point, I knew I must be either getting sick or developing mastitis. The area of my breast was still red, and now it felt warm. I spoke to an advice nurse by phone, who agreed the symptoms were consistent with mastitis and they had the antibiotic prescription ordered.

My first reaction was [expletive]! Then I thought- I finally get a good night’s rest and this is what I get?! The things we breastfeeding women have to deal with! I’m quite sure that not letting my breasts empty overnight contributed to the infection. That side had been getting engorged already, so going 8 hours without breastfeeding or pumping was a bad idea. But the sleep was so great!

Next thought was the antibiotics- I didn’t want to mess around and develop an abscess. Definitely don’t want a collection of pus in my breast. I knew that antibiotics were indicated for this infection, and that the dicloxacillin (a standard treatment for mastitis) was safe to take while breastfeeding. But I couldn’t help but worry about how it would affect the normal flora in my body, and if that might affect WZW. Guess I’ll need to take probiotics and eat fermented foods afterwards. The levels of the medication being excreted in my breast milk should be minimal.

And then I started to feel a little guilty about all the carbs I’ve been eating. In my haze of sleep deprivation, I definitely haven’t been staying strict Paleo, and of course I wondered if some of that sugar had made me more prone to infection. I tried to eat better the next day, and also had the fortune of my husband being home and able to cook. But when it comes down to it, I’m too tired to go back to eating strictly Paleo just yet. I just can’t bring myself to do it.

Thankfully, the mastitis has improved upon starting the antibiotics. I always knew that medications that are to be taken 4 times daily can be difficult to adhere to, and I’m aware of that as a prescriber. But with some conditions like mastitis, I want to go with the standard treatment that I know will generally treat the condition and is also safe with breastfeeding. At least since WZW gets up every few hours or so to feed, it makes it easier to take the antibiotic regularly.

One thing that I didn’t realize about the medication until I got it is that the instructions say to take it with an empty stomach. It says to take one hour before a meal or 2-3 hours after a meal. Now, taking a medication 4 times a day (approximately every 6 hours) and on top of that avoiding mealtimes? That is next to impossible to do it consistently for 10 days. I’m sure it will still work fine to try to adhere to it as best as possible. But to follow the instructions precisely is a tall order, even for someone as anal as me.

I realize there are worse complications that can occur postpartum, and in the scheme of things this ended up not being a big deal. And let me tell you, that grand night of sleep was still worth it! But going through all of this does give me a new appreciation for how much work and unfortunately pain (literally and figuratively) goes into breastfeeding.

Daddy took nighttime duty last night, so overnight he gave WZW a bottle of my pumped breast milk. I thought with him potentially waking up every 3 hours that I might be woken up as early as 4 am to breastfeed, but when I woke up to the clock saying 6:00 I was thrilled! Seven uninterrupted hours of sleep is unheard of these days, and I feel like a new person. Plus at 5 weeks, our little guy is gradually smiling more, so it warms our hearts to see this:

His outfit is courtesy of his uncle, who painted it during our baby shower onesie painting activity. Highly recommended baby shower activity, by the way. Just make sure you get onesies of varying sizes.

I came across this recently in my American Medical Association email:

Children born during summer months may be more likely to be healthy adults

The Huffington Post (10/13, Howard) reports that children born during the summer months appear to be “more likely to be healthy adults,” according to a study published Oct. 12 in the journal Heliyon.

Newsweek (10/13, Firger) reports that the study’s findings were “based on data collected on 450,000 men and women as part of the ongoing United Kingdom Biobank project, a database that tracks health and disease trends.” The study indicates that a pregnant woman’s “exposure to sunlight during the second trimester of a pregnancy may be critical to the development of a fetus.” Being exposed to the sun “helps the body produce vitamin D, an essential building block for good health.”

HealthDay (10/13, Dallas) reports that youngsters “born during the summer were slightly heavier at birth than children born in the winter,” and that “girls born in the summer were more likely to start puberty later.”

Now, I was born in January and spent the first five years of my life in the city of San Francisco before my parents moved us to the sunnier suburbs. For those unfamiliar, San Francisco weather is wacky. Even in the middle of the summer when the rest of the Bay Area is sunny and hot, the City itself, particularly in certain areas, can be foggy, overcast, and gray. If you ever come visit, bring layers! Despite not being a summer baby, I think I turned out ok.

But vitamin D has been a hot topic lately. There’s one doc in my department that’s all about vitamin and mineral supplements, for himself and his patients, and talks about a bunch of bad stuff that vitamin D deficiency causes. Mark Sisson, on his Mark’s Daily Apple website and in his books, often discusses the importance of spending time outdoors and specifically getting some sun.

It’s a balance- skin cancer is not to be taken lightly, as it is relatively common and can be deadly. And on a superficial level, too much sun can cause less desirable cosmetic effects. I myself spent years taking swimming lessons in the summer as a kid, then swam on the swim team in high school. I can’t remember at what point wearing sunscreen became a thing- it definitely wasn’t something we did when I was a young child, but by the time I was in high school in the ’90s, I was slathering it on. Despite that, hours of sun exposure during swim practice and meets resulted in dark spots showing up on my face once I hit my 30s.

But these days, I think we’ve gotten so afraid of the sun and are slathering on sunscreen to the point that we are missing out on the beneficial effects of the sun, including natural vitamin D production. And with our modern lifestyles, people aren’t getting outdoors often. So now the problem is that too many people are developing vitamin D deficiency.

Now that I’ve had a baby, I’ve learned that exclusively breastfed babies are at risk of vitamin D deficiency. The current recommendation is to supplement them once per day. Initially, we bought the standard infant drops at the hospital pharmacy made by Enfamil. When we got home and looked at the ingredients, we saw that like most infant supplements/medications, it was sweetened. In this case, it had glycerin and also artificial flavoring.

It was interesting seeing WZW’s response to the sweetened supplement. We thought, man, how easy would it be to use this stuff to calm our crying baby? Ultimately, we wanted to avoid his sugar exposure as much as possible, so we ended up finding another vitamin D supplement online made by Carlson. It uses coconut and palm oil, and although the dropper is a little tricky, WZW takes the drops just fine.

As an aside, since I’ve mentioned Enfamil which is one of the formula brands, it reminded me that Similac recently put out this hilarious video called The Mother ‘Hood:

I knew Mark Sisson had written a ton about getting sunlight and vitamin D in general, but I wondered if he had specifically addressed the issue with vitamin D and babies. Well sure enough, he did in June 2015 in response to a reader’s question. Turns out that reader found vitamin D supplementation to be a new recommendation for her baby, which was not the case when she had her 4 year-old:

Basically, the 400 IU of vitamin D that’s in my prenatal vitamins (which I’ve still continued since I’m breastfeeding) is probably enough to pass through my breast milk, but not for sure. Particularly if WZW and I aren’t getting enough sun.

Mark Sisson says that increased supplementation for mom is also an option, as is exposing the infant to sunlight:

“Infants aren’t going to burn up because of a minute or two of full sun exposure. Make it a bonding experience. Strip down to your skivvies (the both of you, and bring the other parent along, too) and flop down in the sun. Expose every nook and cranny. Return inside or cover up when the little one’s skin starts to feel warm to the touch. Avoid pinkness. A study from 1985 found that just 30 minutes of full sun per week wearing a diaper was enough to keep vitamin D levels topped off in exclusively breastfed infants — it really doesn’t take much more than five or six minutes a day.”

Of course, if you live in Iceland and it’s the middle of winter, good luck trying to go outside naked. Ultimately, like most things with parenting, it’s going to be a matter of personal choice. And in this case, factors like where you live and how easily you can get sunlight if you want it. I’ll probably do something in between- continue to give WZW the vitamin D drops on the days we remember, but also have him get in a little sunshine regularly as well. And as for me, I’ll continue to religiously slather my face with sunscreen to ward off the wrinkles and age spots.

Parenting means experiencing extremes. On the one hand, spending time with your baby is so fun. Everything he does is the cutest- all of his expressions and movements, whether while sleeping or crying. Best of all is when he’s actually awake and not upset. It’s fun interacting with him, even though the smiles in response to us aren’t consistent yet. Of course we’re biased, and we think he’s the most attractive baby ever. 🙂

It’s a wonder looking at this little human, who is now 5 weeks old. Given his myriad of expressions and actions, and to stimulate his growing brain, I talk to him as if he understands me. Yet I also realize how primitive he is when he’s breastfeeding- he’ll wave his head wildly and then go for my hand or his own fist instead of the breast. Even though he’s been getting noticeably heavier, seeing him with my husband makes me realize the size difference and how little he still is.

On the downside, it is tiring having to care for him 24/7. This week was my husband’s first week back at work. He works less days, but has long work days. So for three days and nights, I was essentially taking care of WZW by myself. It wasn’t as bad as I thought it would be, and I had my mom come over for a few hours one day to help cook dinner. But it is tough when there’s no one to relieve me. One day he had fallen asleep and I had stripped down to hop in the shower when he woke up and started crying. That meant the shower got put on hold.

Speaking of showers, I must admit that even when my husband has been around, I’ve often been skipping days. I guess since I’m mostly at home, it feels like such a hassle daily. It’s not that I dislike showering; in fact I enjoy taking my time. So between the baby and the California drought, I feel like it’s nice to take a leisurely shower, but to do so daily these days is more difficult. I tell myself I’m saving water. And I recently came across a BuzzFeed article that supports that we don’t need to shower daily:

My husband makes fun of my filthy lack of showering, and the fact that I’m using the above excuses.

I think the hardest is at night. Although I’ve been pumping and we’ve started introducing a bottle every other day, I’m primarily breastfeeding. That means that I’m the one who gets up multiple times at night. I’m not the kind of wife that’s going to kick her husband awake (on his off days) just so he can feel my pain. So unless I really need him, I let him sleep so he can function better during the day.

But when I’m the one getting up in the middle of the night, feeling groggy and alone in the dark in my misery, it can be tough. I can’t help but feel bitter that I’m the one with the lactating breasts that has to get up multiple times each night. If it was just a matter of getting up and feeding him and going right back to bed, that wouldn’t be as bad. But sometimes he’ll get fussy while on the breast, so it hurts when he moves his head around and pulls on my nipple. Ouch!

Thankfully, most of the time he goes back to sleep once he’s done, but by the time he’s been fed, burped, and had his diaper changed, easily 45 min have passed. By then I’m hungry, and I can’t go back to sleep. Or maybe it’s from the screen time of going on Facebook while breastfeeding, but by the time I want to go back to bed, my brain is no longer in sleep mode.

Last night, I woke up at 3:30 to feed him, then when all was said and done, I tried to go back to sleep at 4:30. After lying in bed for 15 minutes I realized I was too hungry to do so. So I got up, made some food, and by the time I was ready to go back to bed at 5:30, WZW started to wake up. I tried to put him back to sleep, but it wasn’t working and in my tired state I was getting impatient, so around 6:00 I decided to feed him again in hopes that it would put him back to sleep. Before I knew it, 6:30 had rolled around and he didn’t go back to bed after feeding, so at that point I woke up my husband (who was off work) to take care of him because I desperately needed sleep.

So I’m living the life of the typical new mom. Being tired, I definitely have been straying from staying Paleo. I’ll eat healthy meals half the time, but then the fatigue will make me just want some sugar and carbs. I do feel kinda gross because I’m mostly in the house and am not getting exercise regularly, and am still 10 lbs above my pre-pregnancy weight. But I’m too tired to make the effort to eat better and exercise just yet. Eventually I hope to, as WZW starts sleeping longer hours and such. But for now, I’m gonna try not to beat myself up too much about it.

On the upside, we went to get our flu shots, and an older lady in line asked how old WZW was. She also asked how I lost the pregnancy weight so quickly, so that was a nice compliment. I told her that I didn’t gain too much in the first place, and that breastfeeding burns extra calories. Figured in case she passes along the message to others that it wouldn’t hurt to plant the seed.

One new mom milestone I recently achieved is perfectly depicted by this cartoon:

I woke up one morning to change WZW’s poopy diaper, and was holding his legs up to clean his butt. As I was doing so, he erupted with another poop, which flew straight at me and landed on my shoulder! At that point, all I could do was laugh hysterically as my husband ran out to see what the commotion was about and proceeded to video the aftermath.

Before having WZW, I had never so much as changed a diaper. Once the babies are delivered, I hand them off to the parents and pediatricians, so I was just as clueless as most new parents. Growing up, I never had young children around or needed to babysit. My pediatrician friend recommended the Baby 411 book, which has been very helpful.

What’s funny is that it’s been 30+ years since my mom has had to take care of babies (me and my brother), so when she holds WZW, it’s a little awkward. It’s been a quick learning curve for me, and looks like I’ll have to re-teach my parents if they’re going to help out sometimes with their grandson.

My fatigue makes we want to vent, but I realize these are just the normal experiences of having a newborn, as any new parent knows. Ultimately I’m grateful that WZW is healthy and normal. I can’t imagine how difficult it must be for parents who have babies with medical conditions.

My husband and I have survived 4 weeks of parenting! Things have become more routine now, and as time has passed, WZW has been sleeping better at night and having less episodes of crying for no apparent reason. In other words, things have gotten better in this short period of time.

The sleep-deprivation has gotten more chronic, so the feeling is different than the first week, when I was run by adrenaline or something (probably more like the initial anxiety). My husband described me like a meerkat that first week, acting all hypervigilant. Now, there are times when I feel so tired that as soon as I’ve finished feeding WZW, I will crash and leave my husband to take care of the rest, even if WZW is still fussing and crying. Nothing will stand in the way of my sleep at that point, unless it’s time for WZW to breastfeed.

The breastfeeding is certainly a lot of work- every few hours, I’m immobilized for about half an hour to feed him. I also recently started trying out the pumping, since I want to gradually introduce the bottle to him, and also start storing up breastmilk for when I return to work. While my husband is limited by his lack of a lactating breast, he pulls his weight with WZW’s care and household duties. We’ve done well as a team, and though my parents are retired and live 30 minutes away, we haven’t needed their help on a regular basis.

I will probably need more of their help when my husband returns to work this week, but I’m glad we were able to establish our routine in this early stage as a couple, and for my husband to bond with WZW. Since I often hand WZW off to my husband between feeds, he is more in tune than I am about his body language, like when WZW is working on a little gift for us in his diaper. My husband is also super silly with WZW. I think it’s just his personality, and having a baby is an excuse to let it out in a manner that is socially acceptable. 🙂 Recently, WZW smiled for the first time in response to one of my husband’s antics (as opposed to him only smiling when half asleep). Those babies really know how to get us- just when we’re feeling weary of the sleepless nights, they throw us a bone with that sweet smile, and we’re left panting for more. The social smile is still not regular, but it was fun to get a glimpse of it.

We’ve been making an effort to get out of the house most days. Right after WZW is done breastfeeding, we’ll make a quick trip out to run errands, grab some food, etc. It helps to maintain our sanity, because otherwise it would feel like Groundhog Day- the movie with Bill Murray where he wakes up and relives the same day over and over again. With the constant breastfeeding (particularly the multiple nighttime feeds), diaper changes, and soothing, the days would otherwise all blur together and we would go insane feeling trapped in the house all day.

Now that I’m more chronically tired, I have to say my eating habits haven’t been the best. Yes, I do still eat our healthy crock pot meals, but I also tend to snack a lot. Especially in the middle of the night, I get really hungry after feeding WZW, so I’ll need to eat something before going back to sleep. Often that is a Kind bar, which we’ve bought boxes of at Costco (at least they’re the bars with only 5 grams of sugar). In general, when I’m tired it makes me want to eat more and eat the junk- my tired brain says bring on the ice cream and pizza!

We decided to try out Blue Apron. The service delivers all of the ingredients you need for the recipes you chose for the week. The meals do take prep time, but at least you don’t have to do any grocery shopping for the recipes, and you are given the exact amounts that you need. It’s nice to have my husband make these home-cooked meals, even if they aren’t Paleo. The other service we’re thinking of trying is Munchery, which has chef-cooked meals delivered to you. All you have to do is heat up the food.

Although we get out of the house briefly, we haven’t been getting much exercise. Particularly with the breastfeeding, which requires me to sit for longer periods at a time, I feel kinda gross not walking more like I did during the pregnancy. But with the fatigue as well as limitations with WZW’s feeding schedule, I haven’t been motivated quite yet to start doing anything regularly. One thing at a time.

It’s all so strange how much life has changed in the past month. I was trying to describe how I’m feeling to my husband, but it’s hard to put into words. You spend all this time during the pregnancy in anticipation of the baby’s arrival. During the pregnancy, you gradually prepare for the baby’s arrival, but it’s still nebulous since you don’t know what he looks like. You know the sleepless nights and breastfeeding will be tough, but you don’t quite know what it’s like until it happens.

Now that WZW is here, there’s an element of wonder and amazement that this is my life now- I am now living the life that I had anticipated for so long. I’m not saying it has fallen below or exceeded expectations. It’s just the realization that this is it.

It’s probably one of the biggest life changes I will ever experience. And now that he’s here, in a way it’s hard to imagine life without him. I guess that’s the nature of life- I know looking at bigger babies and older children that WZW will eventually get there, but I can’t quite picture it and what he will look like. And it’s funny how our friends who are parents of older babies look at WZW and say that they can’t believe their child used to be so small. Although parenting can be tough at times, seeing him grow up will be a fun process, especially because they develop and change so quickly.